Form FNS 74 A FNS 74 A QC-Related New Investment Plan

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OMB CONTROL NO. XXXX-XXXX
Expiration Date: XX/XX/XXXX

Department of Agriculture, Food and Nutrition Service
(State)

QC-Related New Investment Plan FFY

(Year)

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is [Insert OMB control number]. The time required to complete this information
collection is estimated to average 32 hours per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information.
This plan is submitted in conjunction with a Settlement Agreement between the

(State and Responsible Agency)
and the United States Department of Agriculture, Food and Nutrition Service, to resolve
’s
(State)
payment error rate liability for Federal Fiscal Year (FFY)
.
’s payment
(State)
(Year)
error rate of
% resulted in an adjusted liability of $
.
(Rate)
(Liability)
Error analyses show that
% of the State’s error cases were attributed to
(Percent of the error rate)
Analyses also show that
% of the State’s error cases were attributed to
(Percent of the error rate)
Analyses also show that
% of the State’s error cases were attributed to
(Percent of the error rate)

(Root cause 1)
(Root cause 2)
(Root cause 3)

.
.
.

To target and reduce the State’s root causes of errors, the following activities will be conducted using State only funds.
1. (Activity 1)
2. (Activity 2)
3. (Activity 3)
4. (Activity 4)
Attached to this submission is an affidavit attesting that reinvestment funds will not replace expenditures already
earmarked for ongoing efforts and that the expenditures are not a reallocation of resources.
Printed Name
Signature
Title

State Agency Program Office

SECTION I: State Agency Information
State Agency

Liability Year

Signed Settlement Agreement Date

Fiscal Year(s) of New Investment Implementation

Required QC-Related New Investment Amount

SECTION II: Identification of Causes of Errors and State’s Plan for Addressing those Causes
A. Root Cause Analysis of leading causes of errors
How did the State arrive at each root cause contributing to its high error rate?
Root Cause 1

FORM FNS-74A (12-16) Previous Editions Obsolete

SBU

Electronic Form Version Designed in Adobe 10.0 Version

Root Cause 2

Root Cause 3

B. The Plan:
Include an overall summary of the plan, its expected error reduction impact(s), and anticipated overall cost relative
to the required, agreed upon, settlement amount.
1. Details of Activity 1
a. Purpose/Description of Activity

b. Root Cause Addressed

c.

Expected Outcome

d. Timeline of Implementation

e. Detailed Cost Estimate

2. Details of Activity 2
a. Purpose/Description of Activity

b. Root Cause Addressed

c.

Expected Outcome

d. Timeline of Implementation

e. Detailed Cost Estimate

3. Details of Activity 3
a. Purpose/Description of Activity

b. Root Cause Addressed

c.

Expected Outcome

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d. Timeline of Implementation

e. Detailed Cost Estimate

SECTION III: Schedule of Progress Report Submission(s) and Contacts
State Estimated Number of Progress Reports Needed
Anticipated Number of Reports Federal Fiscal Year State Anticipates Plan Will be Completed
List of Contacts Responsible for QC-Related New Investment Activities
Financial officer providing status reports to FNS regional office:
Name
Title
Phone Number and E-mail
Technical accountant with primary responsibility for preparing status reports:
Name
Title
Phone Number and E-mail
Program Manager responsible for directing QC New Investment activities:
Name
Title
Phone Number and E-mail
Is information in Column 19 of the SF-425(FNS-778/778A) (refer to 7 CFR 277.11-Financial Reporting Requirements)
prepared by someone other than the persons listed above? If so, please provide the person’s name, title, phone number
and E-mail address.
Name
Title
Phone Number and E-mail
AFFIDAVIT OF ASSURANCE
As the duly authorized officer responsible for the financial operation and reporting of
reinvestment activities, I certify that:

(State and Responsible Agency)

The expenditure of plan of

for Fiscal Year
(Liability Year)
(State and Responsible Agency)
Quality Control (QC) Liabilities is funded with State only money and will not claim any Federal
matching funds for reinvestment expenditures. The expenditures represented in this plan do
not represent a reallocation of ongoing Supplemental Nutrition Assistance Program (SNAP)
resources nor do they replace any expenditure already earmarked for existing efforts.
The activities included in the expenditure plan of

are above
(State and Responsible Agency)
the minimum SNAP requirements dictated by law and regulation. They are not part of any
State Corrective Action Plan.
The requirements for planning and reporting reinvestment activities as described in the
Guidelines for State Agencies for Reinvestment of QC Liabilities are known to me.
Signature

Printed Name

Title

Office

Title

Office

FOR FNS USE ONLY
Plan Review
Approved By Signature

Date Approved

1st Progress Report Due:
May 10

November 10
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Instructions
FNS Form 74A - QC-Related New Investment Plan Template
FNS form 74A is designed to allow for flexibility and should be used as an example of the specific information FNS is
requiring for the QC-Related new investment plan, rather than specifying the amount of activities or the method to be used
in explaining the plan's details or status.
Due Date: QC-Related New Investment Plans are due within ninety (90) days of the effective date of the signed
Settlement Agreement related to the plan.
Structure: The first part of the plan is an introductory memo, summarizing the State-specific plan details and signed by
the State Program official submitting the plan.
Since these new investment plans are designed to specifically target the leading causes of a State's high error rate for a
specific Federal fiscal year, FNS' format requests that the plan be separated into three sections:
Section I identifies the liability year related information;
Section II is broken into two subsections regarding the causes of errors and the State's plan for addressing those
root causes. Subsection A requests an explanation of the analysis that led to the determination of the root causes
that had a significant impact on the State's error rate, and Subsection B requests details about the State's plan for
addressing those root causes by each activity being implemented; and
Section III is designed as a way for FNS and the State to keep track of when progress reports are due, as well as
who in the State Agency will be responsible for implementing the plan as submitted. Section III will be included in
the progress reports for updating, as needed. Progress reports are due every six months (on May 10 and
November 10) after the first progress report is designated until the plan is complete.
The State's final section to complete is the Affidavit of Assurance signed by the financial officer responsible for the plan.
Finally, the “For FNS Use Only” section is designed to ensure the plan is reviewed and approved by FNS. A copy of the
signed approval will be sent back to the State for their record indicating their plan was accepted and informing them of
their first progress report due date.
Special Note: Any new investment plan that identifies a State will use an outside vendor to assist with QC-Related
activities will require additional documentation. FNS intends to review the contract to ensure the activities proposed are
allowable SNAP administrative expenses prior to plan approval.

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